Senate Republicans are intent on overhauling the Affordable Care Act (ACA),but in their haste, they could create a situation where 49 million Americans are uninsured by 2026. According to analysis released in June, the Senate amendment – named the Better Care Reconciliation Act of 2017 -will result in an extra 21 million uninsured people in the United States. Approximately 28 million Americans will have no insurance in 2026 under the existing law. Proponents of the bill point out that it will shave the deficit over the next decade by an extra $119 billion (for a total of $321 billion), but what will it mean for the healthcare system?
The Trouble with the Amendment
In March 2010, there were approximately 57 million uninsured Americans. Then, the ACA came along. By early 2017, the number of uninsured people was just 26 million. Furthermore, the percentage of uninsured people in the United States decreased from 16% in 2010 to just 8.9% in 2016. Thanks to subsidies, approximately 77% of enrollees could purchase insurance for under $100 a month. However, there are some issues with the ACA. For example, a 30-year old will pay an average of $365 a month for a mid-level plan if he or she earns $48,000+ per annum.
Nonetheless, any attempt to repeal the ACA without an adequate replacement would leave tens of millions of people without insurance. As a result, Republicans in the Senate are busy creating an alternative, without much success to date. Its latest attempt to pass a new healthcare act received a damaging blow when the CBO said the legislation would increase the number of uninsured Americans by 23 million within nine years.
The House passed the proposed overhaul of the federal health law in May, and the Republicans had hoped it would also get through the Senate by the end of June. It was an improvement on the original plan in terms of reducing the number of uninsured people and decreasing premiums, but the CBO report dealt serious damage to the proposal. Senate Republicans tried to salvage the proposal by saying it would reduce the federal budget deficit by $119 billion over the next decade, as it plans to cut $834 billion from Medicaid.
According to Mitch McConnell, the Senate Majority Leader, the new and improved plan strengthens Medicaid, keeps access to care for people with pre-existing conditions, and gives Americans greater power to reduce their out-of-pocket expenses and overall medical costs.
Predictably, Senate Democrats were quick to point out the damning data from the CBO report. Chuck Schumer, the Senate Minority Leader, said the report should be the end of “Trumpcare” whereas Bernie Sanders said it was a “cynical and immoral proposal.” Oregon Senator Ron Wyden said it was clear that the Republicans were going in the wrong direction with their healthcare bill.
What is far more worrying for the Republicans is the fact that several members of their party also voiced their concerns over the proposal. Maine Senator Susan Collins said that she couldn’t support the current bill because of the CBO score. Other prominent Republicans including Rand Paul and Dean Heller said they wouldn’t even debate the bill in its existing form. According to Paul, it is worse to pass a bad bill than it is to pass none at all.
The CBO report featured even more bad news. For instance, it pointed out that premiums for senior citizens would escalate, and it gave one example featuring an average 64-year old with an income of $26,500 per annum. For this individual, the net premium for a mid-level plan under the new proposal will be $6,500 per annum after subsidies in 2026 compared to $1,700 under the ACA. A 64-year old with an annual income of $56,800 will pay $20,500 a year with the new bill in 2026; triple the ACA amount.
As the Republicans have a very small Senate majority, the task of gaining the 50 votes necessary to pass the proposal is a tall order, to say the least, now that members of the party spoke out against the new bill. As a result, McConnell elected to delay the vote on the overhaul on June 27. He said they would continue the discussion but did not elaborate on if or when a vote could take place. Indeed, he faced an embarrassing situation when he realized he didn’t even have enough votes to start a debate on the measure.
Nonetheless, McConnell and the other Republicans in favor of the bill continue to press forward in the hope of creating an outline that appeals to Senators. However, senior members of the party believe the challenges are probably too great to overcome. The main reason for the stalemate is a difference of opinion among the party’s conservatives and moderates. As a result, Senate Republicans even missed two informal deadlines set by the party in early July.
Although Senate Republicans are keen to create healthcare legislation to repeal and replace certain parts of the ACA, the party as a whole is unable to create a bill that appeals to enough Senators to pass it into law. Political experts believe there are a few steps the Republicans must take to have any chance of getting the bill through in close to its current form.
First, they could include Ted Cruz’s amendment, which would save healthy people money but result in higher premiums for sick people. The next step involves the reduction of tax cuts to appease moderates. Finally, the Republicans could play the party loyalty card to get the likes of Rand Paul to sign on.
Although the above is realistic, it is also a path fraught with difficulty. McConnell needs 50 out of 52 Senate Republicans to change the bill in a manner that could reduce the level of protection received by people with pre-existing conditions. At present, the Republicans have to change the vote of 12 Senators from “having grave reservations” to “yes.” Moreover, McConnell has until July 28 to get it done because the Republicans are due to leave for summer recess.